Healthcare Provider Details

I. General information

NPI: 1982988515
Provider Name (Legal Business Name): CHARLOTTE G. MERRILL APRN, DNP, FNP-C,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 DONAHUE FERRY RD
PINEVILLE LA
71360-4513
US

IV. Provider business mailing address

16 N LAKE DR
WOODWORTH LA
71485-9511
US

V. Phone/Fax

Practice location:
  • Phone: 318-704-6568
  • Fax: 318-704-6572
Mailing address:
  • Phone: 318-704-6568
  • Fax: 318-704-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06656
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: